Quality use of pathology services

The impact of the implementation of electronic ordering on pathology requesting and the quality and effectiveness of hospital pathology services - building a robust evidence base and benefits framework for successful eHealth diffusion

Project members - Macquarie University

Project main description

This project will provide research evidence, employing key indicators of pathology ordering efficiency and effectiveness, of the impact of electronic test ordering on the utilisation and delivery of hospital pathology services across five hospitals in different demographic settings (major metropolitan, regional, country) within the South Eastern Sydney (Prince of Wales, Royal Hospital for Women and St George) and Illawarra Shoalhaven Wollongong, Shoalhaven) Local Health Networks.

Aims

The project will provide key comparative (across hospitals) and longitudinal (over time) evidence about the effect of electronic ordering systems as well as produce a suite of benefits realisation indicators that can be used to monitor what works (or doesn't work), where, and in what circumstances.

The project will utilise a set of performance indicators to evaluate the impact of electronic ordering on the quality use of pathology across the following areas:

the legibility and completeness of laboratory test orders and the impact on Central Specimen Reception work processes (quality of test orders)

the timeliness of the pathology laboratory process (laboratory turnaround times)

the volume and mix of tests ordered examined by such factors as Diagnosis Related Groups, ward allocation or department and adjusted for clinical activity where appropriate

the impact on re-test and add-on test rates

The outputs of the project will be used to enhance the application of electronic ordering systems in hospital pathology settings.

Design and method

The project will proceed in three stages:

Stage 1 will involve the extraction and linkage of retrospective data across multiple sites to provide baseline measures of data quality, testing ordering volumes and efficiency. It will include the following activities:

submission and approval of ethics application

identification of baseline data by obtaining retrospective data (including from the

time prior to the implementation of electronic ordering) across the five sites

data extraction and linkage of data involving

laboratory information systems

hospital information systems

Emergency Department information systems

audit of laboratory requests to monitor legibility and completeness

work process mapping to evaluate the impact on Central Specimen Reception

Stage 2 will involve data comparisons (to be undertaken six months after Stage 1) to provide longitudinal comparisons and comparisons of data across sites. It will include the following activities:

continuation of data extraction and linkage of data involving

laboratory information systems

hospital information systems

Emergency Department information systems

continuation of audit of laboratory requests to monitor legibility and completeness

continuation of work process mapping to evaluate the impact on Central Specimen Reception

continuation of the provision of data across the five sites will be compared with the baseline data from Stage 1 and changes will be monitored across time and between different sites.

Stage 3 will include data analysis and reporting of all findings from Stages 1 and 2 extraction phases of the project, including the audit of Central Specimen Reception data and work organisation mapping activities.

The drafting and finalisation of a report of key findings, including a benefits realisation package of performance indicators, will be completed by the end of June 2012.